{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T05:47:38Z","timestamp":1783835258440,"version":"3.55.0"},"update-to":[{"DOI":"10.12688\/gatesopenres.15036.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T00:00:00Z","timestamp":1728259200000}}],"reference-count":32,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T00:00:00Z","timestamp":1728259200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns4:p>Background Male sterilization, or vasectomy, is 99.9% effective at preventing pregnancy with less than a 2% risk of complications. Despite the high efficacy, low risk, low cost, and gender equity benefits of vasectomy, just 2% of women reported that they and their partners relied on vasectomy as their contraceptive method globally in 2019. Health care providers can be both a facilitator and a barrier in men\u2019s health generally, and may be in vasectomy provision as well. This study sought to describe the decision-making rationales of experienced vasectomy providers when evaluating patient candidacy in complex cases. Methods Fifteen vasectomy providers belonging to the global Vasectomy Network Google Group from seven countries participated in online interviews using a semi-structured in-depth interview guide. Providers were asked about their vasectomy training, their reasons for vasectomy provision, challenging cases they have faced, and approaches used to manage challenging cases. Vignettes were used to further elicit decision-making rationale. Thematic analysis was conducted using MAXQDA20. Results Provider decision-making was predicated on ensuring patients were well-informed, able to consent, and certain about their choice to have a vasectomy. Once those foundational conditions were met, providers filtered patient characteristics through their training, laws and policies, sociocultural norms, experience, and peer influence to produce a cost-benefit breakdown. Based on the cost-benefit analysis, providers determined whether to weigh autonomy or non-maleficence more heavily when determining vasectomy patient candidacy. Conclusions Despite clinical best practices that promote prioritizing patient autonomy over non-maleficence, some providers continued to weigh non-maleficence over autonomy in vasectomy patient candidacy evaluations. Non-maleficence was particularly prioritized in cases providers deemed to be at higher risk of regret. The findings of this study suggest vasectomy provider training should emphasize evidence-based best practices in shared decision-making and patient-centered care to facilitate vasectomy provision that honors patient autonomy and rights.<\/ns4:p>","DOI":"10.12688\/gatesopenres.15036.2","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T12:05:18Z","timestamp":1728302718000},"page":"132","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Vasectomy provider decision-making balancing autonomy and non-maleficence: qualitative interviews with providers"],"prefix":"10.12688","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4675-3377","authenticated-orcid":false,"given":"Alison T.","family":"Hoover","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominick","family":"Shattuck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Andes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"ref-60","doi-asserted-by":"publisher","first-page":"120-124","DOI":"10.1016\/j.urology.2019.05.035","article-title":"Legal review of vasectomy litigation and the variables impacting trial outcomes.","volume":"131","author":"A Blazek","year":"2019","journal-title":"Urology."},{"key":"ref-1","doi-asserted-by":"publisher","first-page":"142-145","DOI":"10.1016\/j.urology.2019.12.003","article-title":"Childless Men at the Time of Vasectomy are Unlikely to Seek Fertility Restoration.","volume":"136","author":"D Bryk","year":"2020","journal-title":"Urology."},{"key":"ref-2","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-22-00470","article-title":"Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity.","volume":"11","author":"B Bullington","year":"2023","journal-title":"Glob Health Sci Pract."},{"key":"ref-49","doi-asserted-by":"publisher","first-page":"111-114","DOI":"10.1016\/j.urology.2022.11.027","article-title":"Vasectomy regret among childless men.","volume":"172","author":"D Charles","year":"2023","journal-title":"Urology."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"681-692","DOI":"10.1016\/s0277-9536(96)00221-3","article-title":"Shared decision-making in the medical encounter: what does it mean? 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/gatesopenres.16370.r35846, Logan Nickels, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, 02 Feb 2024, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/7-132\/v1#referee-response-35846","order":0,"name":"referee-response-35846","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alison Hoover<\/b>; \n<i>Posted: 03 Aug 2024<\/i>; We thank the reviewers for their time and thoughtful feedback, which contributed to an improved and strengthened manuscript. Our responses to their suggested revisions are below.  \n<b>Reviewer 1<\/b> Are there more references to support the claim in the first paragraph that vasectomy contributes to driving equitable gender norms? Could it not be the opposite, that men with equitable gender norms are more likely to use contraceptive methods? See citation 1.  \n<u>Response<\/u>: We thank the reviewer for introducing this new publication, and have revised the final sentence in the \u201cIntroduction\u201d section accordingly and added the suggested citation alongside another article.   In the final sentence of the introduction - how will addressing supply gaps influence demand gaps as they have been described in the introduction? Their relationship and influence on each other is not clear to this reviewer. Moreover, if it has been suggested that supply is not the main issue behind low vasectomy uptake, does that lessen the importance of this writing?&nbsp;  \n<u>Response<\/u>: The reviewer raised an important consideration about the need for additional evidence regarding the link between supply and demand gaps in vasectomy. This link may best be explored in future write ups. The final paragraph of the \u201cIntroduction\u201d section has been revised accordingly.&nbsp;   Did any of the providers comment on how often they see difficult cases, or if the vignettes were commonplace in any way?  \n<u>Response<\/u>: The vignettes were chosen during study design given their frequency of mention in the Google Group listserv, and are therefore considered to have been confronted by all providers with at least five years of experience (providing vasectomies for at least five years was part of the inclusion criteria for the study). No provider indicated that they had not seen a case included in the vignettes, but commonality was not measured in this study.   Genuine question - In the Methods, should &quot;google group&quot; be capitalized?&nbsp;  \n<u>Response<\/u>: Based on published preferences from Google to have it capitalized, I have capitalized \u201cGoogle Group\u201d in all mentions accordingly.   How many of the providers offered reversals, and how many did not? Were there any differences in how those that provided reversals treated certain vignettes, or viewed the risk of regret versus those that did not?  \n<u>Response<\/u>: We did not specifically collect data on if providers offered reversals. Some providers volunteered that information during their interviews \u2013 three confirmed they provide vasectomy reversals, four confirmed they do not \u2013 but we cannot conclude how many of the remaining providers do or do not provide reversals. As noted in the final paragraph of the \u201cRole of Pre-Procedure Counseling\u201d section, the providers who offer reversals and vasectomies did report that their experience with reversals shaped their counseling practice and their decision-making with vasectomy patients. For the sake of this study, as noted in the third paragraph of the \u201cConclusions\u201d section, whether or not a provider who was known to offer reversals did not appear to meaningfully impact whether they were more likely to prioritize autonomy or non-maleficence.   Was the repeal of Roe mentioned by any of the US providers as motivation, or potentially influential on their decision-making?  \n<u>Response<\/u>: This is an interesting consideration \u2013 however this research took place in December 2020 prior to the repeal of Roe v Wade through the Dobbs decision. It would be interesting to interview providers about their decision-making since the Dobbs decision, and has been added to the \u201cLimitations &amp; Future Research Directions\u201d section.   More context, information, and citations regarding the history of forced sterilization in specific countries would be helpful for this reviewer.  \n<u>Response<\/u>: We have added additional context and a new citation to the \u201cLaws and Guidelines\u201d subsection with one of the first mentions of forced sterilization.   In the final paragraph - why call out non-hormonal methods of male contraception in particular?  \n<u>Response<\/u>: Thank you for noting that \u2013 that should have said non-permanent, not non-hormonal. We have adjusted it accordingly.&nbsp;","URL":"https:\/\/gatesopenresearch.org\/articles\/7-132\/v2#referee-comment-3705","order":1,"name":"referee-comment-3705","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.16370.r35706, Heather Vahdat, Male Contraceptive Initiative, Durham, 12 Feb 2024, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/7-132\/v1#referee-response-35706","order":2,"name":"referee-response-35706","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.16370.r35843, Jay Sandlow, Daniel Pelzman, Urology, Medical College of Wisconsin, Milwaukee, WI, 15 Feb 2024, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/7-132\/v1#referee-response-35843","order":3,"name":"referee-response-35843","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.16370.r35705, Trinity Zan, Research Utilization, Global Health Population and Nutrition, FHI 360, Durham, NC, 26 Feb 2024, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/7-132\/v1#referee-response-35705","order":4,"name":"referee-response-35705","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.16370.r35839, Philip S. Li, Joshua Halpern, Department of Urology, Weill Cornell Medicine, New York City, NY, 24 May 2024, version 1, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/7-132\/v1#referee-response-35839","order":5,"name":"referee-response-35839","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":6,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}